Official SealDepartment of Human Resources


#PBT-0923-080617
Supplemental Questionnaire

Last Name
First Name

 

0923 Manager II, EMS manager

The purpose of the Supplemental Questionnaire is to determine whether you meet the Minimum Qualifications for the 0923, Manager II, EMS Manager.

If you experience technical difficulties, make note of any error messages and contact the analyst before the filing deadline. Responses should be consistent with the information on your employment application and are subject to verification.


1.a

Please select the highest level of education that you have completed.

High School Diploma or equivalent
Associate's Degree
Bachelor's Degree
Master's Degree
Doctoral Degree
None of the above
1.b

Please list the school(s) where you obtained your degree(s) as well as the type of degree earned (e.g. Doctor of Medicine degree from the University of California, Los Angeles). If you do not possess any of the degrees identified above, type N/A

2.a

How many years of professional experience do you have in healthcare?

I have less than one (1) year experience
I have at least one (1) year, but less than two (2) years experience
I have at least two (2) years, but less than three (3) years of experience
I have at least three (3) years, but less than four (4) years of experience
I have at least four (4) years, but less than five (5) years of experience
I have at least five (5) years, but less than six (6) years of experience
I have at least six (6) years, but less than seven (7) years of experience
I have seven (7) or more years of experience
I do not have any experience
2.b

In accordance with your responses to #2A above, please provide the name of the employer(s) and the dates (e.g. MM/YYYY – MM/YYYY) where you obtained the verifiable full-time equivalent work experience.

Additionally, please list the name of (a) supervisor(s) or manager(s) who can verify the information provided as well as his or her contact information. If you do not have experience in these areas, please type N/A.

 

3.

Which of the following valid licenses do you possess?

Registered Nurse (RN) issued by the California State Board of Registered Nursing
Paramedic License (EMT-P) issued by the California Emergency Medical Services Authority
none
4.

Do you possess a valid California Driver's License?

Yes No
 

I understand that checking this box will serve as my electronic signature. I certify that I am the author of this questionnaire and all information presented is true and based upon my education, training, skills, and experience. I understand and agree that any information provided is subject to verification. I also understand that any false, incomplete, or incorrect statement may result in disqualification, termination, or dismissal from employment with the City and County of San Francisco.